
<style>
.b-full{
	width:100%;
	border-bottom:1px solid silver;
	padding-bottom: 2px;
	margin-bottom: 10px;
}

.imieorder input{
	width:40px;
	float:left; 
	margin-left:10px; 
	margin-right:10px;
}
</style>
<?php
/* @var $this SiteController */
/* @var $model ContactForm */
/* @var $form CActiveForm */

$this->pageTitle=Yii::app()->name . ' - Đăng ký vip';
$this->breadcrumbs=array(
	'Đăng ký vip',
);
?>
<div class="vip-form">
<div class="right-box-item">
<h1>Đăng ký vip</h1>
<div style="margin:20px">
<?php if(Yii::app()->user->hasFlash('dangkyvip')): ?>

<div class="flash-success">
	<?php echo Yii::app()->user->getFlash('dangkyvip'); ?>
</div>

<?php else: ?>

<div class="form">

<?php $form=$this->beginWidget('bootstrap.widgets.TbActiveForm', array(
	'id'=>'vip-form',
	'enableClientValidation'=>true,
	'clientOptions'=>array(
		'validateOnSubmit'=>true,
	),
)); ?>
	<?php echo $form->errorSummary($model); ?>

	<div class='b-full' style='color:red;'>	Thông tin bắc buộc (*)</div>
		<div class="row">
			<?php echo $form->labelEx($model,'username'); ?>
			<?php echo $form->textField($model,'username'); ?>
			<?php echo $form->error($model,'username'); ?>
		</div>
	
		<div class="row">
			<?php echo $form->labelEx($model,'hoten'); ?>
			<?php echo $form->textField($model,'hoten'); ?>
			<?php echo $form->error($model,'hoten'); ?>
		</div>
	
		<div class="row">
			<?php echo $form->labelEx($model,'dienthoai'); ?>
			<?php echo $form->textField($model,'dienthoai'); ?>
			<?php echo $form->error($model,'dienthoai'); ?>
		</div>
	
		<div class="row">
			<?php echo $form->labelEx($model,'cuahang'); ?>
			<?php echo $form->textField($model,'cuahang'); ?>
			<?php echo $form->error($model,'cuahang'); ?>
		</div>
		
		<div class="row">
			<?php echo $form->labelEx($model,'diachi'); ?>
			<?php echo $form->textArea($model,'diachi', array('style'=>'width:300px;')); ?>
			<?php echo $form->error($model,'diachi'); ?>
		</div>
		<div class='b-full'>Thông tin dịch vụ của bạn</div>
		
		<div class='row'>
			<?php echo $form->labelEx($model,'tinhthanh'); ?>
			<?php echo $form->textField($model,'tinhthanh'); ?>
			<?php echo $form->error($model,'tinhthanh'); ?>
		</div>

		<div class='row'>
			<?php echo $form->labelEx($model,'quocgia'); ?>
			<?php echo $form->textField($model,'quocgia'); ?>
			<?php echo $form->error($model,'quocgia'); ?>
		</div>
		<div style='width:100%;'>
			<div style='float:left;'>
				<div class='row'>
					<?php echo $form->labelEx($model,'url1'); ?>
					<?php echo $form->textField($model,'url1'); ?>
					<?php echo $form->error($model,'url1'); ?>
				</div>
				
				<div class='row'>
					<?php echo $form->labelEx($model,'url2'); ?>
					<?php echo $form->textField($model,'url2'); ?>
					<?php echo $form->error($model,'url2'); ?>
				</div>
				<div class='row'>
					<?php echo $form->labelEx($model,'url3'); ?>
					<?php echo $form->textField($model,'url3'); ?>
					<?php echo $form->error($model,'url3'); ?>
				</div>
			</div>	
			<div style='float:left; margin-left: 15px; margin-top: 0px;'>
				<div class='row'>
					<?php echo $form->labelEx($model,'url4'); ?>
					<?php echo $form->textField($model,'url4'); ?>
					<?php echo $form->error($model,'url4'); ?>
				</div>
				
				<div class='row'>
					<?php echo $form->labelEx($model,'url5'); ?>
					<?php echo $form->textField($model,'url5'); ?>
					<?php echo $form->error($model,'url5'); ?>
				</div>
				<div class='row'>
					<?php echo $form->labelEx($model,'url6'); ?>
					<?php echo $form->textField($model,'url6'); ?>
					<?php echo $form->error($model,'url6'); ?>
				</div>
			</div>
		</div>
	</br></br></br></br></br></br></br></br></br></br>
	<div class="row">
		<div class='imieorder'>
			<?php echo $form->labelEx($model,'imeifrom', array('style'=>'float:left; margin-top: 5px;  margin-right: 10px;')); ?>
			<?php echo $form->textField($model,'imeifrom'); ?>
			<?php echo $form->labelEx($model,'imeito', array('style'=>'float:left; margin-top: 5px;  margin-right: 10px;')); ?>
			<?php echo $form->textField($model,'imeito'); ?>
		</div>
		
	</div>		<div class='row'>	<?php echo $form->error($model,'imeifrom'); ?>		<?php echo $form->error($model,'imeito'); ?>	</div>
	
	</br>
	<div class='b-full'>Thông tin thanh toán</div>
	<div class="row">
		<?php echo $form->labelEx($model,'nganhang'); ?>
		<?php echo $form->textField($model,'nganhang'); ?>
		<?php echo $form->error($model,'nganhang'); ?>
	</div>
	
	<div class="row">
		<?php echo $form->labelEx($model,'chutaikhoan'); ?>
		<?php echo $form->textField($model,'chutaikhoan'); ?>
		<?php echo $form->error($model,'chutaikhoan'); ?>
	</div>
	
	<div class="row">
		<?php echo $form->labelEx($model,'sotaikhoan'); ?>
		<?php echo $form->textField($model,'sotaikhoan'); ?>
		<?php echo $form->error($model,'sotaikhoan'); ?>
	</div>
	
	<?php if(CCaptcha::checkRequirements()): ?>
	<div class="row">
		<?php $this->widget('MyCaptcha'); ?>
		</br></br>
		<?php echo $form->labelEx($model,'verifyCode'); ?>
		<?php echo $form->textField($model,'verifyCode'); ?>
		<?php echo $form->error($model,'verifyCode'); ?>
	</div>
	<?php endif; ?>
	<div class="row buttons">
		<?php $this->widget('bootstrap.widgets.TbButton', array('buttonType'=>'submit', 'label'=>'Đăng ký', 'type'=>'inverse','htmlOptions'=>array('id'=>'submit'))); ?>
	</div>

<?php $this->endWidget(); ?>
</div></div></div>
</div><!-- form -->

<?php endif; ?>